Policies, Procedures and Forms for the UConn Health Center

Forms
The forms below are in Adobe Acrobat PDF format, and require the Acrobat Reader for viewing. If you don't have the reader, you can download it for free from Adobe. Resources designed to help people with visual disabilities access documents in the PDF format can be found at access.adobe.com.

Alien's Change of Address Card (AR-11)	80K PDF
Alien Data Collection Form	41K PDF
Authorization and Release	58K PDF
Candidate Selection Form	109K PDF
Classified Duties Questionnaire	187K PDF
CSEC	185K PDF
CSEC (BJs Application)	71K PDF
Designation of Retirement System-Tier-Plan-Beneficiary	35K PDF
Direct Deposit Authorization and Input Form	36K PDF
Domestic Partner Affidavit	155K PDF
Dual Employment Request	202K PDF
Employee Request (FMLA-HR1)	168K PDF
Employment Application	145K PDF
Employment Application for Faculty	75K PDF
Employment Eligibility Verification	181K PDF
In-service Course Registration	6K PDF
Medical Certificate, Caregiver	66K PDF
Medical Certificate, Employee	72K PDF
Memorandum of Agreement	48K PDF
Name/Address Change	120K PDF
Payroll Check Pick-Up Authorization Form	64K PDF
Reclassification Request Form	110K PDF
Separation of Employment Clearance	27K PDF
Temporary Service in Higher Classification	14K PDF
Tuition/Conference Fee Reimbursement	106K PDF
Tuition Waiver Request for Dependent Children	109K PDF
Tuition Waiver Request for UHP Employees	24K PDF
UHP Position Information Questionnaire	147K PDF
Violent Incident Report	20K PDF
Voluntary Schedule Reduction Program Form	92K PDF
W-4 CT	47K PDF
W-4 Federal	223K PDF